GW1--06805_Well Construction - GW1_20241114

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• WELL eONSTRUC7110NRECORD .fee.ti*ftul LIlb()NIX; • '
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This roll!am bc•lismit for'shig!aptutulthilowelq4. . • • •• .
1..Weikeciiiipii601lifortn04ii;•
• . 't714;;AVATEMZONES'-- - .- ....„• . .
Chris Huffer - • Flu.MI• • to - . .1 orscitinioN
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. -17el,l0atitOorffaint. . ..
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4223 A
NC.Well'ContiaMatemliftbitibitNuflgel ' • . '-4.150UTEKFASEIGIffit'Ultilliiikilliti,a1WOR-:LINEIllif.ltiiAltiblei', -
1711054' •• • TO • • 'DIAMETER • Ttuctmess- MATERIAL
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SAEDACCO . . • ..it, • fL , i le. - .
:t16•,;,INNERCASINatilVTIIBINILIIM `-'3.' • •
f:cimpmtv l'Ibuil'
. ROM- . TO DULITETER •,, 'MICK-NIS& . ,_SIATERTAL •
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2.:'WO1ltpDitIVilifitt-re.ritil fk, . bt 30 ft 2 ft 30 i " . . --1.4-. SCH4 0 ' PVC
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45'..roitilfliikopt41.4.i.zinii40*.coply.y;$fo,:,.var.kmo.Ireeco'01.clo
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3,'Well Ike(elieeltWella.s0 .
• *-17ISCREEN '
- • - Water Supply Wellt: . • . . - mum'. ...,310 .• . :01A3tV.TCR SLOT 817): THIC1iNMiS I TtIATIVRIAL
- - 30 It I 40 Hi 2 •lit! .010. ' SCH-4 0 PVC
- . . ClAgfisuluttal: . liMpUicipatetiblie. _
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CIGeotherthal(lleatingleooling Supply). 1:Residential Water Supply(single) . ,.. ft • • •
-GROtrri. *--7------t-'-.--:.--_----T.E.-v.:''.1- ---
-C3bidustlialfCemmtcrcial EIResidential.Water Supply(slated)
Tiro's t "i so-• - • 'sMit:TER-Lai • EM.Pnt.A. crC104T.Mzu fob s'AMoUNT
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Irril0 'Oath:in. • 1 .- . f 0 • ft. 23 ft Portland Pour
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l'.ottaWuter Supply Welk.
•-• ft.: .f.l, . . :' .
OtMotiftUtrirag. • . :. ORt.c.oety . . . , • . . . • .
•Injection With.' . ,.. • • - ' -..II.:: • ft; '- i . . . ..,
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. . 0 AttuigrAtOtitiy0 • .-ElOwitindwitter Rentedialiou . • .1-19::.9ANDIGRAVEL.PACKAif.airiili6ittv-r-'----- .. :„,•-.7-...-..: .:::
.. -Kr • :" .1.NI-ern:it:AL, EMPLSCIAIENT;METHOD .
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e3Aipilfer Sititi. Mid l*O.y.ot.'3. F3SOlioity lia trier - • 28 ft.. 40. • ff. Sand' •. #2 ,
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.* tlAquifertcst ' - - - 0Oni11. Cof thilii,age..•. . -
• •. • • . . .. •"• 'R. . Lit.
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1:1,*titnert1al TeehuOtogy . 1?Subsideoco:f..;o:Mol-
...?•14.:Z'RIELiNalli3GWilltaeli.'additioMilitiiitififitecessar0,7 -
f.:1Gguilmtuat(ClifsetlLubp)., • 1:3Tracer . . . . . -.FROM. .TO. DESCRIPTION(COD r. •Sten ilo
ElOWtheultal(FleatingiCaoliug•Retum). -.-'Wilier(explain under.k21•Realatlis) , .14 • ft.. . . .
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-f4. • • ft. •' : • . . .„ . .. • . . •
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4,Bute Weil(s)toniPleletit'.9-182°2 4 Wilt litt#1414-04 .
ft.- • ft. • 1.
l'.• '•• ..: .: •,.1'-••'' .... ,;-- 1 ..7 .
Sa,Well Ltieithin: ,4,.. See Gem''s Notes • - ' - "`'"'"' ' .
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Farmer EtidgeWood.Furnitiare - . .
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- .ft. II. Al3V1 7 2024
F.licililyklymPfeVaPc---. • " Fbtlity I1).'4(ir,appliPb10). - •
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', Iriff.:;:•;:w.'..*:,,.1 P7-:-...,?..-0-;-::-.-,,1 In30. .
42'E. Hudgins St.,. Marion, NC, 28752 ftis: ft.• D'ilP;:e230:3 - • .
• 119*011.1.0.i!4••CiW...°110 PO. ''41-iittEMAHNS'.:)., ' • ,
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McDowell , Bentonite seal from 2328' . • • • •
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. c.,:mmty . • • . 1?-4b47.1*ptillOtibra No,(PIM) . :.. _ . . .- - ,
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• 51f,LitfiliAdeltiftl 2.4agitutle lit deptcsiminutOktOMISar deciitial`degrOesi-. .22.C ertificatiort:' 1 : • -
&vied dehl,one latiloei•issableleta) ' " •-• -
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f Chris R,.uffer . 9/22/2024 • .
Signaitict"b. ciiili4'1Velrea-Mthdt4i.. • Dd.f,. . ., . .. ..-,..
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6.Is(are)the ivell(s): X1Perillanent or• :Effelimoraty.. . • ay stnin dris...toord-lreriby rin, .dir.iye://ty)kroy.07n*roppintacyl iit ii.voilkalr.r
with:1 M...yotc 02C,0100 Or MA-isrPir.02C.:02r11)nu:coiritaidivir Skirp.isur&anct.Oti U
7,Is ttul.a repair to ad Offitiat lvelh• QY.0i- dr .MX0.. •0)&0014 rectitif higs'fi.61.prinliefert iiiilieiir 11 aivirfr, - ' - •
• If tpis.1.0r.i,.,otili,fi:if air knout ii,14•constrak*ti-htlpmittFioq cold i..cplah.t the ligrpre of the - ' •- • •
repizir timkr#2.1iernarkt•iddiIiro 414-imi ihd bral.of this foi,oc .23.Site diugemit or atlditioittl'Wel I details: •, ,. . ' .
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YOU tody use the:1.)40:of ilik:•pifit ib'prolitfi Uddifional Ayell old.ci.0.10.0t well -
. 8.Numberof with eoustrend: 1 • construction details. You thay:Ulsti attach additrotaLpagesitneeesSaty.
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For Auihiplr iqeer4),tof rm7,!ivire.r s..upply ivetkoNLY with dle Fiti. cp.rstiiirdoir,you Cm .
.i4wittoni fpnw.• • suBMErrAt,MST UCtiOrtiS ' • .
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9:Total Well'depth ItetoWlantl suribee: . 40 • • _ - •"0.0 '"24a. 14ir All Welk:. Silluttil this'farm within 39 days.ot:cbippictibu'uf•vieJf
For 4totitibre welkh-st di rkArbsitififAioir(&en.opk,3€.200!(MI 2€,10(1'l • -constructibe to the'folloming-J i : • •
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lu.Static water level below top of casing: . (ft.) Drii'sltin of Water Resources,Information Prdemaing Unit,
vver lev'el Li;theive tirsit*axe'-'4" 16 i710ait Stavie t osier,Raleigh,Ne-276994617
11.Borehole diameter:6" .__(in.) 24h1 For,41-0;.(1op\10.01-1,ONLY: ,In addition to sending the Ibmvto the.adche-Fs. •in
24aabOO,also submit a oby of this form tyithiti...W.diA'of•ouipletiou of ttelt '
12,Well construction.Met hod: sonic- •mmistiactlpit to the following!: P,• ;
(1..Q. .ugcr..rcemf.;.p1)1 :..-tillect rUsit.Mb:} • • . • • 1 , •., • . . . .
. .D6'0Wo if of Water'BeSouroeS,undergroUiul Injection.C.OntrOl•Vrogram,
'FOR WATERS.PPPLYWELE$ONI..17f .1636 Mail Servicenier,Raleigh,74C27699-1636
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24e.Oor•WaterSupply&Injection'Welts:
13it,Yield(gpra) Method Of tmt.:.
..,Niseo submit one cops of thiSfOrdt.:withiti.30 da)S p.1 eotnidetion or r .
ph.Illin,4.*(ionitxpet. i Ama,iint: • wgil.conscOctiiin to fhb•colInti;health‘,/cpiutill)(or the Contittr%%tern•
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Feria GW,l .Norlh Camlha Depimment.of Vsmumingut am:1 Natural Aesatilres-plvis Ion(if Water Eistil:m• flOse.d Augusl:WO
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